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Latest & greatest articles for epilepsy
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on epilepsy or other clinical topics then use Trip today.
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Melatonin as add-on treatment for epilepsy. Epilepsy is one of the most common chronic neurologic disorders. Despite the plethora of antiepileptic drugs (AEDs) currently available, 30% of patients continue having seizures. This group of patients requires a more aggressive treatment, since monotherapy, the first choice scheme, fails to control seizures. Nevertheless, polytherapy often results in a number of unwanted effects, including neurologic disturbances (somnolence, ataxia, dizziness (...) ), psychiatric and behavioral symptoms, and metabolic alteration (osteoporosis, inducement or inhibition of hepatic enzymes, etc.). The need for better tolerated AEDs is even more urgent in this group of patients. Reports have suggested an antiepileptic role of melatonin with a good safety profile.To assess the efficacy and tolerability of melatonin as add-on treatment for epilepsy.We searched the Cochrane Epilepsy Group Specialized Register (May 2012), the Cochrane Central Register of Controlled Trials
Efficacy and Safety of Innovator versus Generic Drugs in Patients with Epilepsy: A Systematic Review Generic antiepileptic drugs achieve blood concentrations similar to those of innovator drugs in healthy volunteers, but their comparative effectiveness has not been well evaluated. Thus, we assessed the efficacy, tolerability, and safety of innovator versus generic antiepileptic drugs. We searched the MEDLINE database, Cochrane Central Register of Controlled Trials, Cochrane Database (...) of Systematic Reviews, and Web of Science for studies that evaluated innovator and generic antiepileptic drugs in patients with epilepsy and reported data on prespecified outcomes. We extracted data on study design, interventions, quality criteria, study population, baseline characteristics, and outcomes. Compared with initiation of innovator antiepileptic drugs, initiation of generic antiepileptic drugs did not significantly alter seizure occurrence (relative risk [RR] 0.87, 95% confidence interval [CI
Ketogenic diet and other dietary treatments for epilepsy. The ketogenic diet, being high in fat and low in carbohydrates, has been suggested to reduce seizure frequency. It is currently used mainly for children who continue to have seizures despite treatment with antiepileptic drugs. Recently there has been interest in less restrictive ketogenic diets including the Atkins diet and the use of these diets has extended into adult practice.To review the evidence from randomised controlled trials (...) regarding the effects of ketogenic and similar diets.We searched the Cochrane Epilepsy Group's Specialised Register (June 2011), the Cochrane Central Register of Controlled Trials (CENTRAL 2011, Issue 2 of 4), MEDLINE (1948 to May week 4, 2011) and EMBASE (1980 to March 2003). No language restrictions were imposed. We checked the reference lists of retrieved studies for additional reports of relevant studies.Studies of ketogenic diets and similar diets for people with epilepsy.Three review authors
Partial-onset seizures in epilepsy: perampanel as adjunctive treatment P Partial-onset seizures in epilepsy: per artial-onset seizures in epilepsy: perampanel as ampanel as adjunctiv adjunctive treatment e treatment Evidence summary Published: 14 December 2012 nice.org.uk/guidance/esnm7 pathways Ov Overview erview The content of this evidence summary was up-to-date in December 2012. See summaries of product characteristics (SPCs), British national formulary (BNF), BNF for children (BNFc (...) ) or the MHRA or NICE websites for up-to-date information. Key points from the evidence Perampanel is a first-in-class selective, non-competitive antagonist of the AMPA glutamate receptor. It is licensed for the adjunctive treatment of partial-onset seizures with or without secondarily generalised seizures in people aged 12 years and older with epilepsy. The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care (NICE clinical guideline 137
Epilepsy Surgery OHTAC Recommendation: Care for Drug-Refractory Epilepsy in Ontario Ontario Health Technology Advisory Committee July 2012 2 Background During an evidence review of brain imaging technology (magnetoencephalography [MEG]) (Functional Brain Imaging), the Ontario Health Technology Advisory Committee (OHTAC) became aware of the fact that epilepsy surgery is an effective technology for people with epilepsy refractory to drug treatment. In the process of determining the number (...) of patients to whom this technology may apply, the Medical Advisory Secretariat, the predecessor of Health Quality Ontario, identified the following preliminary statistics: ? Only about 2% of Ontario patients eligible for epilepsy surgery receive the surgery, which is similar to other jurisdictions. ? Significant wait times (greater than 1 year) are associated with obtaining diagnostic testing to determine eligibility for surgery. As a result, OHTAC recommended a field evaluation to further explore
Deep brain stimulation for refractory epilepsy (IPG416) Overview | Deep brain stimulation for refractory epilepsy | Guidance | NICE Deep brain stimulation for refractory epilepsy Interventional procedures guidance [IPG416] Published date: January 2012 Share Save Guidance The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Deep brain stimulation for refractory epilepsy. Description Epilepsy (...) into brain Plus Y53.3 Approach to organ under computed tomography scan control And/or Y53.7 Approach to organ under magnetic resonance imaging control In addition an ICD-10 code from category G40.- Epilepsy is assigned. Your responsibility This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements
Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. Despite reported success, surgery for pharmacoresistant seizures is often seen as a last resort. Patients are typically referred for surgery after 20 years of seizures, often too late to avoid significant disability and premature death.We sought to determine whether surgery soon after failure of 2 antiepileptic drug (AED) trials is superior to continued medical management in controlling seizures and improving (...) quality of life (QOL).The Early Randomized Surgical Epilepsy Trial (ERSET) is a multicenter, controlled, parallel-group clinical trial performed at 16 US epilepsy surgery centers. The 38 participants (18 men and 20 women; aged ≥12 years) had mesial temporal lobe epilepsy (MTLE) and disabling seizues for no more than 2 consecutive years following adequate trials of 2 brand-name AEDs. Eligibility for anteromesial temporal resection (AMTR) was based on a standardized presurgical evaluation protocol
The efficacy and safety of retigabine and other adjunctive treatments for refractory partial epilepsy: a systematic review and indirect comparison Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Cost effectiveness of lacosamide in the adjunctive treatment of patients with refractory focal epilepsy in Belgium Cost effectiveness of lacosamide in the adjunctive treatment of patients with refractory focal epilepsy in Belgium Cost effectiveness of lacosamide in the adjunctive treatment of patients with refractory focal epilepsy in Belgium Simoens S, De Naeyer L, Dedeken P Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED (...) . Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary The objective was to examine the cost-effectiveness of lacosamide, added to standard anti-epileptic drug therapy, for patients with refractory focal epilepsy. The authors concluded that the addition of lacosamide appeared to be cost-effective, for patients with difficult-to-treat epilepsy, in Belgium
Sudden unexpected death in epilepsy. Sudden unexpected death in epilepsy (SUDEP) refers to the sudden death of a seemingly healthy individual with epilepsy, usually occurring during, or immediately after, a tonic-clonic seizure. The frequency of SUDEP varies depending on the severity of the epilepsy, but overall the risk of sudden death is more than 20 times higher than that in the general population. Several different mechanisms probably exist, and most research has focused on seizure-related (...) respiratory depression, cardiac arrhythmia, cerebral depression, and autonomic dysfunction. Data from a pooled analysis of risk factors indicate that the higher the frequency of tonic-clonic seizures, the higher the risk of SUDEP; furthermore, risk of SUDEP is also elevated in male patients, patients with long-duration epilepsy, and those on antiepileptic polytherapy. SUDEP usually occurs when the seizures are not witnessed and often at night. In this Seminar, we provide advice to clinicians on ways
Responsive cortical stimulation for the treatment of medically intractable partial epilepsy This multicenter, double-blind, randomized controlled trial assessed the safety and effectiveness of responsive cortical stimulation as an adjunctive therapy for partial onset seizures in adults with medically refractory epilepsy.A total of 191 adults with medically intractable partial epilepsy were implanted with a responsive neurostimulator connected to depth or subdural leads placed at 1 or 2
The long-term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: a cohort study. Surgery is increasingly used as treatment for refractory focal epilepsy; however, few rigorous reports of long-term outcome exist. We did this study to identify long-term outcome of epilepsy surgery in adults by establishing patterns of seizure remission and relapse after surgery.We report long-term outcome of surgery for epilepsy in 615 adults (497 anterior temporal resections, 40 (...) ·4, 1·5-3·9). Relapse was less likely the longer a person was seizure free and, conversely, remission was less likely the longer seizures continued. In 18 (19%) of 93 people, late remission was associated with introduction of a previously untried antiepileptic drug. 104 of 365 (28%) seizure-free individuals had discontinued drugs at latest follow-up.Neurosurgical treatment is appealing for selected people with refractory focal epilepsy. Our data provide realistic expectations and indicate
Cost-effectiveness of pediatric epilepsy surgery compared to medical treatment in children with intractable epilepsy Cost-effectiveness of pediatric epilepsy surgery compared to medical treatment in children with intractable epilepsy Cost-effectiveness of pediatric epilepsy surgery compared to medical treatment in children with intractable epilepsy Widjaja E, Li B, Schinkel CD, Ritchie LP, Weaver J, Snead OC, Rutka JT, Coyte PC Record Status This is a critical abstract of an economic evaluation (...) that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary This study assessed the cost-effectiveness of epilepsy surgery in children with intractable epilepsy. The authors concluded that surgical treatment was cost-effective compared with medical therapy, but larger samples and longer follow-up were required
[Usefulness of video EEG for the assessment of patients with refractory epilepsy] Utilidad del video EEG en la evaluacion de paciente con epilepsia refractaria [Usefulness of video EEG for the assessment of patients with refractory epilepsy] Utilidad del video EEG en la evaluacion de paciente con epilepsia refractaria [Usefulness of video EEG for the assessment of patients with refractory epilepsy] Pichon Riviere A, Augustovski F, Garcia Marti S, Glujovsky D, Lopez A, Rey-Ares L, Bardach (...) of patients with refractory epilepsy] Buenos Aires: Institute for Clinical Effectiveness and Health Policy (IECS). Informe de Respuesta Rapida No 220. 2011 Authors' objectives To assess the available evidence on the efficacy, safety and issues related coverage policies for the use of Video EEG. Authors' conclusions In patients with refractory epilepsy who have previously been studied using the standard diagnostic tests, telemetry video electroencephalography (V-EEG) seems to be an adequate diagnostic test
[Vagus nerve stimulation for refractory epilepsy] Estimulacion del nervio vago para la epilepsia refractaria [Vagus nerve stimulation for refractory epilepsy] Estimulacion del nervio vago para la epilepsia refractaria [Vagus nerve stimulation for refractory epilepsy] Pichon Riviere A, Augustovski F, Garcia Marti S, Glujovsky D, Lopez A, Rey-Ares L, Bardach A, Regueiro A, Alcaraz A, Valanzasca P, Elorriaga N, Romano M, Rojas J Record Status This is a bibliographic record of a published health (...) technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Pichon Riviere A, Augustovski F, Garcia Marti S, Glujovsky D, Lopez A, Rey-Ares L, Bardach A, Regueiro A, Alcaraz A, Valanzasca P, Elorriaga N, Romano M, Rojas J. Estimulacion del nervio vago para la epilepsia refractaria. [Vagus nerve stimulation for refractory epilepsy] Buenos Aires: Institute for Clinical Effectiveness and Health Policy (IECS). Informe de
Challenges and recommendations for conducting epidemiological studies in the field of epilepsy pharmacogenetics Epilepsy is one of the most prevalent neurological disorders, afflicting approximately 50 million Indians. Owing to affordability and easy availability, use of first-generation antiepileptic drugs (AEDs) is heavily encouraged for the treatment of epilepsy in resource-limited countries such as India. Although first-generation AEDs are at par with second-generation AEDs in terms (...) of efficacy, adverse drug reactions (ADRs) are quite common with them. This could be attributed to the inferior pharmacokinetic parameters such as nonlinear metabolism, narrow therapeutic index and formation of toxic intermediates. In addition, epilepsy patients may differ in the pharmacokinetic and pharmacodynamic profiles, with about 1/3(rd) of the population failing to respond to treatment. A proportion of this interindividual variability in response may be explained by genetic heterogeneity
Felbamate as an add-on therapy for refractory epilepsy. Epilepsy is a chronic and disabling neurologic disorder, affecting approximately one per cent of the population. Up to 30% of people with epilepsy have seizures that are resistant to currently available drugs. Felbamate is one of the second generation antiepileptic drugs and its effects as an add-on therapy to standard drugs are assessed in this review.To evaluate the efficacy and tolerability of felbamate versus placebo when used (...) as an add-on treatment for people with refractory partial-onset epilepsy.We searched the Cochrane Epilepsy Group Specialized Register (6 December 2010), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 6 December 2010), and PubMed (6 December 2010). There were no language restrictions. We reviewed the reference lists of retrieved studies to search for additional reports of relevant studies. We also contacted the manufacturers of felbamate and experts in the field
Strategies for improving adherence to antiepileptic drug treatment in patients with epilepsy. Poor adherence to antiepileptic medications is associated with increased mortality and morbidity. In this review we focus on interventions designed to assist patients with adherence to antiepileptic medications.To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medications in adults and children with epilepsy.We searched the Epilepsy Group's Specialised (...) Register (24 June 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2) and electronic databases: MEDLINE (OVID) (1950 to June 2010); EMBASE (OVID) (1980 to 2010 Week 24); CINAHL (1982 to June 2010) and PsycINFO (22 June 2010), and the reference lists of relevant articles. Randomised or quasi-randomised controlled trials of adherence-enhancing interventions aimed at patients with clinical diagnosis of epilepsy (as defined in individual studies), of any